13-1566 (MECH)f, .
• ��- P.O. BOX 1504 ��►,
78-495 CALLE TAMPICO 44q-
LA QUINTA, CALIFORNIA 9225 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 1`,0.0.01566 Owner:
Property Address: 80485 RIVIERA WESTERGAARD DENNIS R
APN: 762-200-013- - - 80485 RIVIERA
Application description: MECHANICAL LA QUINTA, CA 92253 D
Property Zoning: LOW DENSITY RESIDENTIAL (
Application valuation: 8520
Contractor:
Applicant: 9 Architect or Engineer: HYDES
Cj�� i1/ / 1V,�// /Y 42949 MADIO STREET _
/�/'(�/ INDIO, CA 92201
(760)360-2202
Lic. No.: 906115
LICENSED CONTRACTOR'S DECLARATION
I hereby.affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
license a s: 17,20 6 License No.: 906115
Date: _. ! Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that 1 am exempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
(_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
Contractors' State License Law does not apply to an owner' of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
one year of completion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.).
(_ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
I—) I am exempt under Sec. , B.&P.C. for this reason
Date: Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name: _
Lender's Address:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/04/13
p u
0
,p b 6 2013
LA
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
for by Section 3700 of the Labor Code, for. the performance of the work for which this permit is
issued.
_ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier NORGUARD INS Policy Number CEWC468841
I certify that, in the performance of the work' for which this permit is issued, I shall not employ any
person in any manner so as to become subject to he workers' compensation laws of California,
and agree that, if I should become subject t orke1s' compensation provisions of Section
/ 3700 of the Labor Code, I shall font co ly those provisions.
Date: (i _ _Applicant:.
WARN( NG:_FAI LURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose request and for
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of thispermit.
2. Any permit issued as a result of this application becomes null and void if work is not commenced
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby a horize rep sentatives
of this y to�nter upon the above-mentioned property for inspecti pur ses.
L
'Date: —7 �Signatu�re (Applicant or Agent):
Application Number 13-00001566
Permit . . . MECHANICAL 2013
Additional desc .
Permit Fee 71.50 Plan Check Fee
.00
Issue Date Valuation
-0
Expiration Date 6/02/14
Qty Unit Charge Per
Extension
1.00 35.7500 EA MECH FURNACE
35.75
1.00 35.7500.EA MECH CONDENSER/COMP
35.75
---------------------------_---------------------
Special Notes and Comments
HVAC CHANGE OUT PACKAGED UNIT CHANGE OUT
78o AFUE 13 SEER 5 TON 2008 ENERGY]
CARBON MONOXIDE ALARM(S) TO BE INSTALLED
PRIOR TO FINAL INSPECTION. 2010 CBC...
--------------------------------------------=-------------------------------
Other Fees . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
PERMIT ISSUANCE M/P/E
90.57
PLAN CHECK,.MECHANICAL
47.66
Fee summary Charged Paid Credited
Due
Permit Fee Total 71.50 .00 .00
71.50.
Plan Check Total .00 .00 .00
.00
Other Fee Total 139.23 .00 :00
139.23
Grand Total 210.73 .00 .00
210.73
LQPERMIT
Bin #
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Pen"*
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Project Address:'
A. P. Number.
Contractor. -/- I
e
6fid
Address: -
City, ST, Zip:
Telephone.
State loic. #: q
Areb-, Engr., Designer,
Address:
City, ST, Zip:
Telephone:
State Lit~ #:
Name of Contact Person,
Telephone # of Contact Person:
# Submittal Req'd
Plan Sets
Structural Calm
Truss Caics.
Energy caics.
Flood plain plan
Grading plan-
Subcont2ctor List
Grant Deed
EMAL Approval
IN HOUSE--
Planning Approval
Pub. Wks. pp
W— Ar-
School4—
Fees .
"I
City Of. La Quints
Budding & Safety Division
P.O. Box 1504, 78-495 Cade Tampico
La Quinta, CA 92253 - (760) 777-7012,
Building Permit Application and Tracking Sheet
rc. 0I.Mees Name: W4
Address:
City, ST. Zip:
Telephone:
Project Description:
C4
Lic. #: '-(j -L
Total Permit F"
ConstructionType:
culNulcy:
P0iectype (circle 2one):
.
New A:ocAlter Repair' Demo
Sq. Ft:
#Storiesunits.
Estimated Value of Project
APPUCANT: DO NOT WRITE BELOW THIS
UNE
TRACING
•
PERMIT FEES
PlanChecksubmitted
item
Amount
Reviewed, ready for correddow
Plan Check Deposit
Called Contact P&sou
Plan Chick BWance
Plans picked up
Construction
Plan S resubmitted
.
Mechanied
2" Review, ready for correcti onalissue
Electrical
Called Contact Person
Plumbing
Plans picked up
SALL —
------
Plans rubmitted
'es
resubmitted
-
------------
Grading
Review,
Review, ready f6re'orrectionsrLunt
Mveloper-Impact Fee
Called Contact Person
AJLP.P.
Date of permit issue
Total Permit F"
r
i
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations • CF -IR -ALT -HVAC
Climate Zones 10 - 15
Site Address: -
Enforcement Agency:
Date:
Permit #:
807485 Riviera La Quinta, CA 92253
City of La Quinta
Dec 2, 2013
Duct insulation
Conditioned Floor
Equipment Type1
List Minimum Efficiency2
requirement
Area
Thermostat
® Package Unit .
❑ Furnace
❑ Indoor Coil
® AFUE 78%
IM SEER 13.0
13 COP
❑ HSPF
[3R 6 (CZ 10-13)'
Served by system
'
®Setback
If not already present, must be
[3 Condensing Unit
[3 EER
❑ Resistance
❑ R 8 (CZ 1.4 -IS)
2000 sf
installed)"
❑ Other
.
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -IR -ALT -HVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems.
HERS VERIFICATION SUMMARY Listed below are FOUR HVAC alteration Options. The installer decides what work is being done
and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall
be left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this
form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF -6R and registered CF -4R
forms (no hand filled CF-4Rs allowed) are filled out and sig ned.Beginning October 1, 2010, a registered copy of the CF -111
and CF -611 shall also be on site for final inspection.
® 1. HVAC Changeout
Required Forms:
. All HVAC Equipment
CF -6R forms: MECH-04, MECH-2I-HERS -Ra (for split -., «e.. �. ------ 25 �=o=
replaced
CF -4R forms: MECH-21 and (fer split . . - . ---- --
. Condenser Coil and /or
CF -6R forms: MECH-04, MECH-2I-HERS and (fete so lit '.. f +tel MFCIJ 7G_LICDG
. Indoor Coil and /or
CF -411 forms: MECH-21 and (f9- split systems) MEG14- 4
. Furnace
— , TMAW
For Packaged Units: Duct leakage: < 15 percent
Exempted from duct leakage testing; if:
❑ 1. Duct system was documented to have been previously sealed and confirmed through HERS verificEtion, or
❑ 2. Duct systems with less than --.---.4-0 linear feet in unconditioned space, or
❑ 3. Existing duct systems are constructed insulated or sealed with asbestos
❑:4 ThSSystemfwi.11 not be Ducted (iery,Ductless:Mirn Split System)$(Also Ex empt'from�Refngera.nt Charge)
❑ 2. New HVAC System
Requ!red.
. Cut in�or Changeout with
` *Eh i Q ; 4f
CF_ 6R forms MECH 20 HERS and (for split systems) MECH 22 HEIS, and
new ducts (all new
ducting and all new
tiMECH-04,
MECH `25 _HERS AQ
r
�,
CF 4R forms MECH 20, and (for split systems) MECH 22; and MECH 25 4 ti
r �°
equipment)::...,
�.
For, Split Systems Duct leakage <r6 percenb; RC, CGA�> 350 CFM/ton; FWD, TMAH TMS, and either'HSFP'oe-PSPP
For Packaged Units: Duct leakage'<6 percent "
❑ 3.. NewDucEs'with/or without
Required Forms:
Replacement t
. Includes replacing or installing alfnew
ducting and/or outdoor condensing unit
CF -6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
and/or indoor coil and/or furnace :No or some
CF -4R forms: MECH-20 and (for split systems) MECH-25
equipment changed.
For Split Systems: Duct leakage < 6. percent; RC, CCA >- 300 CFM/ton, TMAH
For Packaged Units: Duct leakage < 6 percent
❑ 4. New Ducting over 40 feet — Required Forms:
. Includes adding or replacing more than 40 CF -6R forms: MECH-04, MECH-2I-HERS
linear feet of duct in unconditioned space. CF -4R forms: MECH-21
For split system or packaged units: Duct leakage < 15 percent
❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos.
Contractor (Documentation Author's /Responsible Designer's Declaration Statement)
. I certify that this Certificate of Compliance documentation is accurate and complete.
. I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design iden`ified on this Certificate of
Compliance.
. I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 24, Parts 1 and 6 of the California Code of Regulations.
. The design features identified on this Certificate of Compliance are consistent with the information documented on other•,applicable compliance
. forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application.
Name: Mark Hyde Signature: Mark Hyde
Company: CERTIFIED' COMFORT SYSTEMS INC Date: De-- 2, 2013
Address: 77-825 WILDCAT DRIVE License: 906115
City/State/Zip: PALM DESERT / CA / 92211 Phone: (. 60) 360-2202
Reg: 213-A0089896A-000000000-0000 Registration Date/Time: 2013/12/02 17:29:43 HERS Provider:.CalCERTS, Inc.
2008 Residential Compliance Forms July 2010